Accepted Manuscript

The Long-Term Benefits of Dog Ownership in Families with Children with Autism
Sophie S. Hall, Hannah F. Wright, Annette Hames, PAWS Team
PII:

S1558-7878(16)30034-X

DOI:

10.1016/j.jveb.2016.04.003

Reference:

JVEB 965

To appear in:

Journal of Veterinary Behavior

Received Date: 17 November 2015

Revised Date:

29 March 2016

Accepted Date: 12 April 2016

Please cite this article as: Hall, S.S., Wright, H.F., Hames, A., PAWS Team, The Long-Term Benefits
of Dog Ownership in Families with Children with Autism, Journal of Veterinary Behavior (2016), doi:
10.1016/j.jveb.2016.04.003.
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The Long-Term Benefits of Dog Ownership in Families with Children with Autism

Authors: Sophie S. Hall. Hannah F. Wright. Annette Hames. PAWS Team. Daniel S. Mills.

Corresponding Author: S. S. Hall

University of Lincoln

Joseph Banks Laboratories

School of Life Sciences

Lincoln,

Lincolnshire,

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Email: shall@lincoln.ac.uk

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Tel: 0781739077

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H. F. Wright: University of Lincoln, Lincoln, UK; hwright@lincoln.ac.uk

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A. Hames: University of Lincoln, Lincoln, UK; aehames@hotmail.com

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D. S. Mills; University of Lincoln, Lincoln, UK; dmills@lincoln.ac.uk

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PAWS Team; Dogs for Good, Banbury, UK; peter.gorbing@dogsforthedisabled.org

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Abstract

There is growing interest in Animal Assisted Therapy in the treatment of Autism Spectrum

Disorders. Despite the potential promise for pet dog ownership to improve the lives of those

affected by autism, there is limited research in this area. This study is the first to explore the

long-term effects of acquiring a pet dog. Using standardized self-report measures, families

who had acquired a pet dog (intervention group; n = 22) showed significantly improved

family functioning in comparison to control group families (n = 15, with no dog). Both

groups showed reductions in domains of parenting stress. These reductions were more

evident in the intervention group; 20% of parents moved from clinically high to normal stress

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levels. In the domain of parent-child dysfunctional interactions reductions were only

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observed in the intervention group. A significant positive relationship was observed between

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parenting stress of the childs main carer and their attachment to the dog.

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Keywords: Pet dogs; Autism Spectrum Disorder; Family Functioning; Parenting Stress.

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Introduction

Neurodevelopmental impairments, including autism, form the largest group of disabled

children in the UK and USA (Blackburn et al. 2012; Perou et al., 2013). Autism spectrum

disorder (ASD) is a heterogeneous condition defined by the DSM-5 as a person experiencing

persistent difficulties in verbal and non-verbal interactions, which result in functional

limitations (e.g., in a social and educational context). These problems must have been evident

in early childhood, cause significant impairment in functioning and not be explainable by

intellectual disorders or developmental delays (DSM-IV, APA 2013). Parents to children

with autism spectrum disorder (ASD) often have reduced quality of life, with high anxiety

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and stress related problems (Dunn et al., 2001), in comparison to other parents (Lach et al.,

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2009). There is growing recognition that caregiver and family-based factors influence the

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effectiveness of ASD treatments (Fisman et al., 2000; Tunali & Power, 2002). Research

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suggests that supporting the childs main carer directly benefits the child, improving behavior

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management (e.g. Brereton & Tonge 2005; Tonge et al., 2006; Green et al. 2010) and sibling

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adjustment (Quintero, 2010), suggesting that the development of effective interventions that

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support the wider family unit may also bring direct benefits to the child with ASD.

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There is growing scientific and clinical interest in the value of placing trained autism
assistance dogs in the homes of children with ASD. Studies have shown that autism

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assistance dogs increase child safety, outdoor access, and enhance communication and social

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interaction with other people (Burrows et al., 2008; Redefer & Goodman, 1989). Parental

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reports suggest that the presence of an assistance dog in the home results in reduced child

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anxiety, and this is supported by studies showing decreased cortisol awakening response in

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children with autism following placement of the dog, which increase again following removal

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of the animal (Viau et al., 2010). It is possible that the calming effect of the dog on the child

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and the ability for the family to engage in activities outside the home also benefits wider

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family members, including the childs main carer. Furthermore, as the dog is likely to be

primarily cared for by the childs main caregiver the presence of the dog may bring direct

benefits to the caregiver, in terms of a therapeutic stress reducing effect (e.g., Allen et al.,

1991, 2001) and by providing the opportunity to get outside of the home environment by

taking the dog for a walk, which may increase the opportunity for social interactions

(McNicholas & Collis, 2000). If such mechanisms improve quality of life for the carer then

this may have a consequently positive effect on the childs ASD behaviors.

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The hypothesis that the presence of a dog in the family may bring wider benefits to

the family members, such as reduced stress through mechanisms such as improved family

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behaviors, increased me time, greater social interactions when engaging in dog walking,

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and reduced stress through the therapeutic contact with dog, may all be achieved from a pet

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dog as opposed to a trained assistance dog. Only recently have studies begun to look at how

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pets, without any specific training, may offer similar benefits to children with ASD and their

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families. These studies report increase improved pro-social behaviors (Bystrm & Lundqvist

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Persson, 2015; Grandgeorge et al., 2012), a reduction in restrictive behavior patterns

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(Bystrm & Lundqvist Persson, 2015) and improved child interactions and bonding

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experiences (Carlisle, 2014) with the addition of a pet (not necessarily a dog). Only one

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known study has reported the effects of acquiring a pet dog to the main carer to a child with

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ASD. Wright et al. (2015a, 2015b) measured family functioning and parenting stress in

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families with a child with autism during the first year of dog ownership (intervention group;

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n=42) in comparison to families who did not acquire a pet dog during this time (control

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group; n=28). Significant improvements in family functioning (reduced family weaknesses,

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increased strengths) were identified in the intervention group (n=42; dog owners) compared

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to the control group (n=28; non-dog owners). The intervention group also showed significant

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improvements in the parenting stress (total stress, parental distress and difficult child

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domains) in comparison to the control group (Wright et al., 2015b). These findings are

compatible with evidence that suggests that pets can provide a pivotal role in family

functioning (Cain, 1983; Walsh, 2009) and that pets can help reduce depressive moods

(Krause-Parello, 2012), stress (Allen et al., 1991), and offer comfort in times of need

(McConnell et al., 2011).

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These investigations suggest that acquiring a pet dog can bring a range of benefits to
families affected by ASD during the first year of dog ownership, but the durability of the

benefits reported remain unknown. Given that acquiring a dog is a life-long commitment, it is

essential that realistic expectations are set for any potential long-term benefits. Therefore, the

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aim of this study was to evaluate the longer term effects of dog ownership in the families who

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were studied by Wright et al. (2015a, 2015b), approximately 2.5 years after initially acquiring

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a pet dog, using the same outcome measures employed in the original studies. When

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considering the long term effects of dog ownership, it is also useful to consider the

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attachment bond that has formed between the dog and the main parent carer over time, since

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this might affect the value derived from the relationship. Therefore, a secondary aim of the

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study was to explore relationships between family functioning and parenting stress and pet

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attachment.

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Method

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Participants

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Participants were recruited for the original studies on a voluntary basis via Dogs for the

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Disableds PAWS (Parents Autism Workshops and Support) network (Dog for the Disabled

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2013; since re-named Dogs for Good) and advertisements through the National Autistic

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Society (see Wright et al., 2015a, 2015b for further details). Participants were asked to take

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part in the study if their child had a confirmed diagnosis of autism spectrum disorder and was

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aged between 3-16 years. Because of the heterogeneous nature of ASD we did not have

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exclusion criteria relating to the condition for participation, which allowed us to obtain a

sample that reflected the disparity of characteristics of families in the general population. All

children had received a clinical diagnosis through Children and Adolescent Mental Health

Services (CAMHS), and this diagnostic process was confirmed by the parents. These

families/parents had received no specialized service dog training for children with ASD.

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Contact was made with parents, who had completed the scales at the last data collection

point, and whom we knew had not requested to be withdrawn from any future studies. There

were 42 sets of parents in the intervention group and 24 in the control group. In the

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intervention group 22 (52.4%) of these families chose to participate in the long-term follow

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up; 7 families were not contactable via phone or email; 13 withdrew from the study (reasons:

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1 re-homed dog, 2 family stressors; 10 chose not to be involved/ did not provide an

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explanation). The average age of the dog originally acquired by these families was 3.35

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months (mean) 4.65 (standard deviation) (range: 2 24 months); 13 of the dogs were

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female and 9 were male; 15 were purebreds (2 cocker spaniels, 2 Cavalier King Charles

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spaniels, 2 retrievers, 2 miniature schnauzers, 2 Labradors, 1 Jack Russell terrier, 1 West

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Highland white terrier, 1 fox terrier, 1 Border collie, 1 Bernese mountain dog) and 7 were

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cross-breeds (3 spaniels poodles, 3 Labradors poodles, 1 Labrador whippet). In the

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control group 15 (53.6%) families participated; 9 families withdrew (reasons: 3 obtained a

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dog, 2 were not contactable, 4 chose not to be involved). Across the intervention and control

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group data was collected from 37 families.

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Family functioning (Brief FAM-III-General Scale; FAM-III-GS). Of the 37

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participants who responded to the FAM-III GS one participant in the control group declined

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to answer some of the questions. The remaining data set comprised 36 participants, 22 in the

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intervention group and 14 in the control group (see Table 1). The time elapsed since baseline

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measures were taken (pre-intervention; up to 17 weeks before acquiring a dog for the

intervention group and matched time points for the control group) was 2.61 years 0.05

(Mean Standard Error Mean), since post-intervention measures were taken it was 2.37

years 0.06, and 1.91 years 0.05 since follow-up measures were recorded.
Parenting stress (Parenting Stress Index-Short Form; PSI-SF). Of the 37

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participants who completed the PSI-SF, three participants (2 = intervention; 1 = control) were

removed from analysis for low scores (10 or below) on the defensive responding scale,

indicating that that their responses may be biased to present a favourable impression, in

accordance with the PSI manual (Abidin, 1995). The time elapsed since baseline measures

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were taken (pre-intervention) was 2.71 years 0.07 (Mean Standard Error Mean), since

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post-intervention measures were taken it was 2.51 years 0.07, and 2.00 years 0.07 since

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follow-up measures were recorded. Demographics for the sample retained in the analysis are

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provided in Table 1.

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Apparatus and Materials

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With the aim of being able to make direct comparisons with original studies conducted by

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Wright et al. (2015a, 2015b) we replicated the tests used in these studies.
Family functioning. To measure family functioning we used the Brief FAM-III,

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General Scale (Skinner et al., 1995). We used the General Scale (14 items), which is designed

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to measure basic family functioning, is suitable for use when measuring family functioning

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over time (Skinner et al., 1995) and is effective at discriminating between problem and non-

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problem families (see Skinner et al., 1983). Example items include We feel loved in our

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family and We can rely on family members to do their part. Each item is scored on a four-

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point scale, from 0 = strongly agree, to 3 = strongly disagree. Seven items are reverse scored.

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Reported alpha coefficients for the General Scale are high, = 0.93 (Skinner et al., 2000).

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Parenting stress. To measure parenting stress we administered the Parenting Stress

Index (III edition), Short Form (PSI-SF; Abidin, 1995). The PSI-SF is an abbreviated version

of the original 120 item form; comprised of 36 questions, it takes approximately 10 minutes

to complete. The 36 questions measure three domains of stress; 12 items measure Parental

Distress (PD) (e.g. I often have the feeling that I cannot handle things very well), 12 items

Parent-Child Dysfunctional Interaction (P-CDI) (e.g. My child rarely does things for me that

make me feel very good), and 12 items measure perception of Difficult Child (DC) (e.g.

My child seems to cry or fuss more often than other children). These three sub-scales (PD,

P-CDI, DC) combine to provide a score of Total Stress (TS). Items are scored on a five-point

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scale from Strongly Agree to Strongly Disagree. The PSI has been well used with parents

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to children with autism (e.g. Hastings, 2003; Hoffman et al., 2009; ZaidmanZait et al. 2010).

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The PSI short form was designed for use by clinicians working under time restrictions in

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primary health care settings and for research purposes. As documented by Abidin (1995) the

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short form scales have satisfactory test-retest reliability scores (TS: 0.84, PD: 0.85, P-CDI:

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0.68, DC: 0.78) and good internal reliability coefficients () (TS: 0.91, PD: 0.87, P-CDI:

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0.80, DC: 0.85).

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Attachment to the dog. We used the widely used Lexington Attachment to Pets
Scale (LAPS; Johnson et al., 1992) to measure the affectionate bond between the main parent

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carer and the dog. This 23 item scale includes items such as Quite often I confide in my pet

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and I love my pet because it never judges me. Each question is scored on a four point scale

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from 0 = strongly disagree, to 3 = strongly agree, with two items being reverse scored. The

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questions comprise one scale with a high coefficient = 0.93 (Johnson et al., 1992).

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Procedure

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Parents provided written informed consent. All testing procedures complied with BPS Ethics

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Code of Conduct (2009) and were approved by the Life Sciences University of Lincoln

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Ethics committee. Parents were contacted via the telephone at an agreed date and time. The

researcher read the questions and response options to the parents and recorded the parents

responses. Forms were scored anonymously; the researcher who collected the data did not

have access to the parents responses from the earlier studies. No time restriction was set on

answering the questions; the interview typically lasted for 40-45 minutes. Participants were

assured of their anonymity and encouraged to answer as honestly as possible.

Data Analysis

To assess whether scores on family functioning and parenting stress data were significantly

different at long-term follow up between the intervention and control group, and to assess

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whether scores on these scales changed over time we conducted analysis of co-variance

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(ANCOVA). The within subjects factor was time (post-intervention, follow-up, and long term

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follow-up). The between subjects factor was group (intervention, control). We used baseline

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scores as co-variate to control for any differences between the groups due to sampling

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characteristics prior to the start of the intervention. To explore whether the owners

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attachment to the dog was related to scores of family functioning and parenting we conducted

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a Pearsons correlation between scores on family functioning (FAM-III-GS) and parenting

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stress (PSI-SF) with scores on pet attachment (LAPS).

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We recognised that the reduction in sample size over the study period may alter the

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statistical ability to detect effects at the group level, and lead to an inappropriate failure to

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reject the null hypothesis. To guard against this we calculated effect size (Cohens d; Cohen

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1969) and power using G*Power (Faul et al., 2007) (Table 2).

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[Insert Table 2]

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To assess whether there was statistical evidence to support a continued improvement in

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parenting stress associated with dog ownership we conducted a chi square analysis to

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investigate if a significant number of parents had moved from clinically high (in the 90th

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percentile, as defined by the PSI manual; Abidin, 1995) to clinically normal stress levels,

between follow-up and long-term follow-up. To explore for potential relationships between

parenting stress and family functioning we conducted a Pearsons correlation between scores

on the FAM-III-GS at Long-term follow-up and scores of parenting stress. To assess whether

the owners attachment to the dog was related to scores of family functioning we conducted a

Pearsons correlation between scores on the FAM-III-GS or PSI scores (total and 3

constituent elements) at long-term follow-up with scores on the Lexington Attachment to Pets

Scale (LAPS).
Results

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Family Functioning

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For the ANCOVA comparing the intervention and control group in family functioning, a

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significant effect of group (F(1, 32) = 4.71, p = 0.037, p = 0.125; see Table 3 and Figure 1)

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revealed lower scores in the intervention group compared to the control group, reflecting

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decreased family difficulties and increased family strengths. The analysis showed no

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significant effect of time (F(2, 66) = 0.583, p = 0.561) on scores of family functioning. No

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significant time group effect was observed (F(2, 66) = 0.074, p = 0.928). Inspection of the

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graphed data (Figure 1) suggested that different changes may have occurred within the two

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groups over the sampled time points, and that the control group may show decreased family

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difficulties between follow-up and long-term follow-up. To assess the significance of this

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observation we conducted paired samples t-tests separately for the intervention and control

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group. For the intervention group a significant reduction in family difficulties from baseline

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to long-term follow-up (t(21) = 2.69, p = 0.01) a nearly significant difference from post-

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intervention to long-term follow-up (t(21) = 1.84, p =0 .07) and no significant difference

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from follow-up to long-term follow-up (t(21) = 1.50, p = 0.17). In the control group no

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significant differences were observed (baseline to long-term follow-up: t(13) = 0.34, p = 0.73,

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post-intervention to long-term follow-up: t(13) = 1.80, p = 0.08, Follow-up to Long-term

follow-up t(13) = 1.41, p = 0.17). The overall effect size for group, accounting for baseline

scores, was large (0.8) and was consistent with that obtained in the initial study (Table 2).
[Insert Figure 1 and Table 3]

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Relationship with dog attachment. Not all participants chose to complete the LAPS
(those that did not complete the LAPS were under personal time constraints); therefore

analysis was conducted on a population of 17 parents. The analysis revealed no significant

correlation between LAPS and FAM-III scores (r = 0.072, n = 17, p = 0.785).

Parenting Stress

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To assess whether there was a difference in PSI scores between the intervention and control

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group over time an ANCOVA was conducted. There were no significant effects of group or

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time (all ps > 0.05), buta comparison of effect sizes of group showed similar, albeit non-

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significant, trends at long-term follow-up to that achieved in the original studies (Table 2).

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The largest effects in the original studies were observed in the domains of Total Stress and

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Difficult Child (both of large effect). At long-term follow-up these effect sizes were

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classified as medium to large effect. The smallest effect sizes in the original studies were

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associated with scores on Parent Distress and Parent Child Dysfunctional Interactions (of

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medium to small effect). In this study these effect sizes were small, to approaching medium

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in size. To further address the aim of evaluating the nature of the long-term effects of

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acquiring a pet dog in these families, we explored mean scores within the PSI sub-scales.

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Comparison of mean scores also revealed some potentially interesting individual trends

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(Table 3 & Figure 1). The difference in percent decrease between the two groups was greater

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in the intervention group by 35% for Parental Distress, 97% for Parent-Child Dysfunctional

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Interactions, 50% for Difficult Child and 59% for Total Stress. To further investigate these

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trends and to assess changes that may have occurred within the groups over the duration of

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the intervention we conducted paired sample t-tests separately for the intervention and control

group. Significant changes were observed in the Intervention group in the domains of Parent

Distress (decrease from Baseline to Long-term follow-up; t(13) = 2.30, p = 0.04), Parent-

Child Dysfunctional Interactions (decrease from baseline to long-term follow-up; t(19) =

2.07, p = 0.05), Difficult child (decrease from baseline to long-term follow-up; t(19) = 2.46, p

= 0.03, and from post-intervention and long-term follow-up t(19) = 3.00, p = 0.03 and Total

stress (decrease from baseline to long-term follow-up; t(19) = 2.85, p = 0.01). Significant

changes were seen in the control groups for the domains of Parent Distress (decrease from

baseline to long-term follow-up; t(19) = 2.06, p = 0.05), Difficult Child (decrease from

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baseline to long-term follow-up; t(19) = 2.48, p = .02) and Total Stress (decrease from

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baseline to long-term follow-up; t(19) = 2.71, p = .02). No significant changes were observed

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in Parent-Child Dysfunctional Interactions. As seen in Table 3, there was a tendency for a

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decrease in parenting stress in the intervention group compared to the control group,

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although most comparisons across time were not significant. Effect sizes were reduced in the

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smaller population sampled in this study in comparison the original population (Table 2), and

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were of medium (Total Stress, Difficult Child) or small (Parent-Child Dysfunctional

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Interactions, Parental Distress) size. These effect sizes reflect those obtained in the original

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sample.

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In the intervention group 20% of parents (4/20) moved from high to normal levels of

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parenting stress, in the control group no parents showed a clinical but non-significant

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decrease in total stress, and one parent moved from clinically normal to clinically high stress

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( (1, N = 34) = 3.17, p = 0.07).

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Relationship with dog attachment. There was a significant positive correlation

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between scores on LAPS and Difficult Child (r = 0.570, n = 17, p = 0.01), higher scores on

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difficult child were associated with higher scores of pet attachment. No significant

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correlations were observed between LAPS and Parental Distress, Parent-Child Dysfunctional

Interactions and Total Stress (ps > 0.05).

Discussion

Our long-term follow-up study shows that the short-term benefits to family functioning

associated with acquiring a pet dog (Wright et al., 2015a, 2015b) appear to be largely

maintained 2.5 years after acquiring the dog, in families where obtaining a dog proved to be a

successful addition to the family and the dog was not relinquished. We observed some trends

towards a greater reduction of parenting stress in the dog owning group compared to the non-

dog owning group, but these effects were not statistically significant. Additionally, we

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identified a relationship between attachment to the dog and parenting stress. We first briefly

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discuss the findings relating to the effects in family functioning and parenting stress before

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considering potential mechanisms, limitations and implications of this work.

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Family Functioning

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Significantly reduced family difficulties (increased family strengths) were observed in

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families who acquired a pet dog compared to families who did not acquire a pet dog,

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indicating that improved family functioning was maintained 2.5 years later (see Wright et al.

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2015a). The family functioning assessment was completed by the main parent carer to the

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child with ASD, and therefore represents the main parent carers perception of family

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functioning. Visual inspection of the graphed data and comparison of the means suggests that

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families in the control group experienced a fluctuation in family functioning over the study

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period, whereas families in the intervention group experienced steady, gradual reductions in

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family difficulties. Given that the Brief-Fam-III General Scale measures functioning of the

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entire family rather than that of an individual the lack of a significant relationship between

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parent attachment to the dog and family functioning is not surprising.

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Parenting Stress

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Parenting stress scores revealed trends to a greater reduction in all domains of parenting

stress (total stress, parental distress, parent-child dysfunctional interactions and difficult

child) in the intervention group compared to the control group. However, these between

group effects were not statistically significant in our population and may be explained by the

generally low statistical power achieved. From baseline to long-term follow-up both groups

showed a significant decline in parenting stress in the domains of total stress, parental

distress, and difficult child. It could be suggested that over time parents may adapt to the

demands having caring for a child with ASD, regardless of whether or not they own a pet

dog. It is worth noting that only the intervention group showed a significant decline in parent-

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child dysfunctional interactions during this time. Of potential importance is that whereas 20%

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of parents in the intervention group moved from clinically high to clinically normal stress

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levels, no clinical-level improvements were observed in the control group, and one parent

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moved from clinically normal stress levels to clinically high stress levels. Overall, the data

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indicate that the stress associated with parenting a child with autism reduces over time, and

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these reductions may be facilitated with the acquisition of a pet dog. These findings generally

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support the short-term effects of dog acquisition reported by Wright et al. (2015b). However,

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whilst Wright et al. (2015b) reported statistically significant changes to parenting stress

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during the early stages of acquiring a dog, the scores at long-term follow-up were not

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statistically different between the intervention and control group. Whilst it should be

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considered that the greatest benefits of dog ownership on parenting stress may only be

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evident in the initial stages after obtaining a dog, as we have previously mentioned the lack of

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statistically significant results may also be the result of reduced statistical power. It should

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also be considered that as the dog-parent relationship matures other factors mediate the

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strength of the protective value of dog ownership against parenting stress. One such factor to

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consider is the attachment bond between the parent and the dog. Indeed, we observed an

interesting relationship between scores of pet attachment and parenting stress.

A significant positive correlation emerged between scores of difficult child and

LAPS. This indicates that parents who perceive their child as being difficult have greater

attachment to their dog. It is not possible to determine the causal nature of these relationships,

but the relationship between parenting stress and pet attachment supports evidence indicating

that adults turn to their pets in times of need (Kurdek, 2009). It is noticeable that the domain

of parenting stress which relates most directly to the childs behaviors is that which

demonstrates a relationship with dog attachment. This is consistent with suggestions that

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there is a link between the type of bond formed between owners and pets as there is between

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parent and child (Archer, 1997). Indeed, similarly to children, pets are seen as dependents but

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also a source of amusement and play (Berryman et al., 1985); when the positive aspects of the

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parent and child relationship break down (as evidenced in scores of difficult child) it appears

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that the dog-owner bond increases. It is possible that this increase derives from humans need

15

for feeling related (a basic psychological need to be in a close relationship) (Deci & Ryan,

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2000); as the care-giving relationship between child and parent is increasingly difficult the

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parent seeks this similar caring relationship through attachment to their dog (see Stenseng,

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2013). It has been proposed that greater attachment to a pet creates dissociation (the lack of

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integration of various parts of an experience such as thoughts, feelings, or images into the

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stream of consciousness; Carlson et al., 1993) (see Brown & Katcher, 1997, 2001).

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Dissociation could help protect parents from stress, but it could also reduce diligent

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parenting. However, our data show no evidence for parent-dissociation; greater attachment to

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a dog was associated with greater perceptions of child difficulty. If pet attachment produced

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dissociation we would expect greater attachment to the dog to relate to reduced child

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difficulties. We are careful to point out these results are based on a small sample of parents,

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nonetheless, they represent an important foundation for future research questions which could

have important implications for both the effectiveness of pet-dogs to improve the quality of

life those affected by ASD and for the welfare of dogs in these families.

Possible Mechanisms

The purpose of this research was to establish proof of concept for pet dog ownership as a

method to improve the lives of those affected by autism; in this case the main parent carer to

a child with ASD. As such, the measurements employed make it difficult to determine the

exact mechanisms behind the observed improvements Previous research suggests that animal

companionship can reduce stress and anxiety in typical and atypical populations (e.g.,

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OHaire, 2010, 2013; Smyth & Slevin 2010; Viau et al., 2010), and such reductions in the

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parent and/or the child may indirectly affect both parenting stress and family functioning.

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Other possible considerations are that the dog may increase social support, and that dog

13

ownership is associated with greater social interactions (McNicholas & Collis, 2000) and

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feelings of support (McConnell et al., 2011). The dog may provide an excuse for increased

15

social interactions in the family, as a common talking point and interest (Walsh, 2009) or

16

through chance encounters when dog walking (McNicholas & Collis, 2000). Additionally, the

17

act of dog walking alone provides time away from it all which could be an important

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contributor to improving wellbeing. Indeed, when collecting the data informal

19

communications with the parents suggested that the dog walk represents a valuable

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opportunity for freedom to many parents. As well as the mental break, the psychological

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benefits of the cardiovascular effects of exercise on stress are well documented (e.g., Fetzner

22

& Asmundson, 2014; Salmon, 2001). Future research could focus on the relationship between

23

what parents do with their dogs and whether the activities in which they engage affect family

24

functioning and relationships. A final point to mention is that in our original studies (Wright

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et al., 2015a, 2015b) we considered the possibility that the acquisition of something new in

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the family altered family interactions which improved stress and family functioning, but that

the improvements may not be specific to the dog and could be observed with, for example,

the addition of a new baby. Given that the average age of the dog acquired by families was 3

months it could also be that the cute and funny stage associated with owning a puppy

improved wellbeing, but that this would not be maintained as the dog grew older. If this was

the case then we would expect deteriorations in family functioning and parenting stress when

the novelty of the dog has reduced at long-term follow-up, not the sustained improvements

that we observed. Although, given that studies report the unique effects of dogs, as a species,

in reducing stress (e.g. Allen et al., 1991), we cannot conclude this at present, and future

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studies would need to consider the effects of other pets on the family.

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Implications and Limitations

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This is the first study to report long-term benefits of dog ownership in families with children

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with ASD, specifically the benefits to the main parent carer to the child.

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It extends pervious work in this field to show that pet dogs, as well as trained assistance dogs

15

can improve family normalcy (Burgoyne et al., 2014) and demonstrates that the positive

16

effects observed in family functioning during the early stages of pet dog ownership

17

(Grandgeorge et al., 2012; Wright et al., 2015a) are maintained 2.5 years later. This study

18

provides important information to parents and clinicians when considering pet ownership as

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an effective family intervention and directly responds to the need to provide up-to-date

20

information on how to help parents improve family functioning using a flexible, integrative

21

approach (Solomon & Chung, 2012). Specifically, the data indicate that acquiring a dog can

22

bring considerable improvements to family functioning and shows some support for

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maintaining long-term improvements to parenting stress levels. Family based factors have

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been identified as being important to consider in the development of autism therapies

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(Herring et al., 2006; Higgins et al., 2005). Indeed, high parent stress is associated with

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increased severity in disruptive child behaviors, which in turn elevates parenting stress

(Baker et al., 2003), anxiety and depression (Hastings & Brown, 2002; Sofronoff & Farbotko,

2002). Additionally increasing family functioning is thought to benefit children with autism

(Herring et al., 2006; Rao & Beidel, 2009). It is difficult to make direct comparisons with

existing family interventions (e.g., Robbins et al., 1991; Shields & Simpson, 2004) due to a

range of protocol differences (i.e., child age, baseline scores, measure of stress used,

type/lack of control group). Nonetheless, our findings provide promise for future research to

compare changes in stress and family functioning between those acquiring a dog, those in

another family-based intervention, and those in a control group.

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We acknowledge that our findings are based on a relatively small sample, that was

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self-selected (parents responded to advertisements), but they provide important support for

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the value of further investment using larger samples. Given that longitudinal studies with

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participants samples that have neurodevelopmental, social and behavioral disorders are

14

typically problematic in maintaining participation (e.g., Cotter et al., 2005) our greater than

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50% recruitment is a satisfactory percentage to achieve and comparable to those achieved in a

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study of a 3 year follow up concerning families with a child with autism (51%: Manti et al.,

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2011). Due to the nature of the intervention, it was not possible to randomly assign a pet dog to

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a family or to utilize Propensity Score Matching on the sample (see Wright et al., 2015c). These

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results are only relevant to families who wish to acquire a pet dog and believe that a pet dog

20

may be a suitable addition to their family, which is a non-random population. We recognise

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that for some families the challenging conditions of living with a child with autism may cause

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significant welfare implications for the dog and the child,so acquiring a pet dog may not be an

23

effective strategy for all families living with a child with autism. . It is vital that we inform

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scientific and clinical practice about the longer-term effects of acquiring a pet dog to these

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families, as publications of the immediate effects, only, may lead to unrealistic expectations.

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Despite the potential for pet dogs as an effective family intervention we would like to
note that given the highly individualised nature of autism, dog ownership may benefit some

families more than others and acquiring a dog should only be taken after a due consideration

(Carlisle, 2014). Further research is required to help us understand which families are most

likely to benefit from dog ownership. We did not make our own independent evaluation of

the type and severity of the autistic symptoms of the children involved and instead we relied

on parental report. This was the procedure in the original studies (Wright et al., 2015a,

2015b). Given that parents had to give us 40-45 minutes of their time, with no tangible

reward, there is little incentive for parents to be dishonest in reporting their childs diagnosis,

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but future studies should consider the need for this additional control.

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Conclusion

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This long-term follow-up study highlights the potential benefits of pet dog ownership in

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bringing relatively long-term improvements to the lives of families living with a child with

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autism, particularly the main parent carer. These enduring improvements apply primarily to

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reducing family difficulties, although there is some evidence of promise for dog ownership

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reducing parenting stress long-term. These conclusions pertain only to families who are

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willing to acquire a dog and the relationship is satisfactory. This research has significant

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implications for veterinary, clinical and family practice and highlights the necessity for

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further high quality research in this area.

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Ethical Statement

21

All testing procedures complied with BPS Ethics Code of Conduct (2009) and were carried

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out in accordance with The Code of Ethics of the World Medical Association, Declaration of

23

Helsinki.

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ACCEPTED MANUSCRIPT
Acknowledgements

The project received funding from the Morris Animal Foundation; Grant Code / Title:

D14HA-008 / Long Term Effects of Pet Dogs on Families with Children with Autism. The

funders were not involved in the design of the study, data collection, data analysis and

preparation of the report.

Conflict of Interest

The authors report no conflict of interest.

Authorship Statement

The idea for the paper was conceived by Mills and the PAWS team. The experiments were

10

designed by Mills and the PAWS team. The experiments were performed by Hall, Wright,

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Hames and the PAWS team.

12

The data were analyzed by Hall. The paper was written by Hall, Wright and Mills.

13

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Table 1

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Summary of Participant Demographics in the Intervention and Control Group

Demographic Item*

Family Functioning Scale

Parenting Stress Index

Intervention

Control

Intervention

Control

(n=22)

(n=14)

(n=20**)

(n=14)

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(All data is % except for child age)
Parents
85.7

80

85.7

Household status (One parent) 36.4

28.6

40

28.6

Children
Childs age (years) 11.63 0.06

28.6

No siblings 18.2

7.1

One sibling 54.5

50

Childs Diagnosis
Autism diagnosis 18.2
Autism spectrum diagnosis 27.3

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Aspergers / High functioning 50

Autistic traits 4.5
Childs Language Ability

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None verbal 4.5

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Single words / gestures 18.3

Simple phrases / sentences 4.5
Full sentences 72.7

Medication taken for autistic

22.7%

25.0

28.6

20

14.3

60

50

20

35.7

14.3

20

21.4

71.4

20

64.3

14.3

55

14.3

7.1

7.2

20

7.2

35.7

28.6

57.1

70

57.1

28.6%

25%

28.6%

42.80

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Two or more siblings 27.20

11.85 .2.92 11.5 4.21

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Gender (Female) 22.7

11.21 1.19

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Gender (Female) 81.8

symptoms
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2
3
4

*Demographic Item: Within categories, mutually exclusive; ** Total number of participants = 37, see text for reasons of removal from
analysis

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Table 2

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Effect Size and Power of the Main Effect of Group

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d = Effect sizes are Cohens d calculated using G*Power: Small = 0.2, Medium = 0.5, Large = 0.8

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*Original Data: This refers to the power of the data collected in the first studies conducted by Wright et al. (2015a, 2015b).

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3

Original Data*
Power

0.8

0 .99

0.8

0.99

Total Stress

0.8

0.99

0 .5

0 .80

Parental Distress

0.6

0.99

0.3

0.38

0.8

0.99

0.6

0.92

0.2

0.34

0.1

0.08

Family Functioning

Difficult Child
Parent-Child Dysfunctional Interaction
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PSI-SF

Power

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d
FAM-III-GS

Long-Term Follow-up

SC

Scale

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Table 3
Changes between baseline and long-term follow-up for the intervention and control group
Intervention Group

Control Group

Baseline

Scale

Long-term

MeanSEM
Diff

RI
PT

MeanSEM
Baseline

Follow-up

Diff

Follow-up

FAM-III-GS
9.221.15

2.96

PSI-SF

12.281.82

11.711.68

0.57

35.642.19

33.352.29

2.29

SC

Family Functioning 12.181.33

Long-term

35.701.65

32.151.89

3.55

Parent-CDI

36.301.64

33.101.61

3.20

31.421.34

31.351.17

0.07

Difficult Child

47.301.21

43.201.92

4.10

46.282.03

44.212.25

2.07

Total Stress

119.303.57

108.404.69

10.9

113.353.69

108.924.19

4.43

M
AN
U

Parent Distress

AC
C

EP

TE
D

Parent-CDI = Parent-child dysfunctional interactions, Diff= Difference between the two scores.

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Family Difficulties (Functioning)
Dog Owners (Intervention):
Non-Dog Owners (Control):

15
14

*BL: Baseline
PI: Post-Intervention
FU: Follow-up
LTF: Long-term Follow up

13
12

RI
PT

11
10
9
8
PI

FU

LTF

SC

BL

Difficult Child

M
AN
U

Parent Distress
36

48

34

46

32

44
42

BL

PI

TE
D

30

FU

LTF

BL

EP

Parent-Child Dysfunctional Interactions

34
32

AC
C

36

PI

FU

LTF

Total Stress

120
115
110

30

105
BL

PI

FU

LTF

BL

PI

FU

LTF

Figure 1. The longitudinal effects of acquiring a pet dog on family functioning and parenting
stress (PD, DC, P-CDI, TS).
*The time elapsed since measures of family functioning were taken was: pre-intervention =
2.61 years 0.05; post-intervention = 2.37 years 0.06; follow-up = 1.91 years 0.05. The

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AC
C

EP

TE
D

M
AN
U

SC

RI
PT

time elapsed since measures of parenting stress were taken was: pre-intervention 2.71 years
0.07; post-intervention measures = 2.51 years 0.07; follow-up = 2.00 years 0.07.

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RI
PT
SC
M
AN
U
TE
D
EP

A long-term follow up of families with children with autism who acquired a pet dog
Improvements to family functioning was maintained 2.5 years later
20% of parents who acquired a pet dog moved from clinically high levels of parenting
stress to normal levels
Parenting stress was related to attachment to the dog

AC
C